Table 6.

Studies related to the impact of ENTS

Topic	Type	Description	Results	Validity evidence	Study
Prospective assessment of ENTS	Assessment	Prospective evaluation of safety practices in endoscopy. Evaluation of ENTS using framework	Varied ENTS scores. Endoscopists scoring higher ENTS scores more likely to perform safety checks (p<0.001).	Relationship to other variables.	Matharoo et al 35
Assessment of ENTS in emergency endoscopy	Assessment	Prospective assessment of ENTS during emergency procedures.	ENTS scores positively correlated with DOPS and safety checklist scores. Patient safety incidents inversely correlated with ENTS scores.	Internal structure. Relationship to other variables.	Matharoo et al 36
ENTS competency during training	Assessment	Collated assessable domains in 8601 DOPS and compared ENTS with other domains.	ENTS competency increased with lifetime procedural count. ENTS competency correlated strongly with other assessable domains.	Internal structure. Relationship to other variables.	Siau et al 37
Development of MARS tool	Assessment	Development of a multiassessor rating scale using ENTS framework. Four domains, 10 items per domain and 7-point rating scale.	MARS tool practical to administer. Good internal consistency and acceptable inter-rater reliability.	Internal structure (for MARS tool).	Kokwara et al 40
Implementation of MARS tool in practice	Assessment	Use of MARS to provide 360 assessment of independent endoscopist ENTS. Nine endoscopists rated by 10 raters (nurses).	Significant differences in domains observed by use of 10 raters. Useful in providing feedback to endoscopists.	Internal structure. Consequences (for MARS tool).	Hawkes et al 41
Validation of paediatric gastroscopy DOPS	Assessment	Prospective national study of paediatric gastroscopy DOPS. Averaged ENTS scores compared with overall procedural scores.	For 157 DOPS, ENTS scores significantly correlated with overall competency scores (p<0.001).	Internal structure. Relationship to other variables.	Siau et al 38
Validation of paediatric colonoscopy DOPS	Assessment	Prospective national study of paediatric colonoscopy DOPS. Averaged ENTS scores compared with overall procedural scores.	For 61 DOPS, ENTS scores significantly correlated with overall competency scores (p<0.001).	Internal structure. Relationship to other variables.	Siau et al 39
ENTS team training	Training	ENTS incorporated into a training day for Bowel Cancer Screening teams to improve knowledge and attitudes around patient safety.	Significant improvement in patient safety knowledge and 29% of safety attitude question items.	N/A	Matharoo et al 44
ENTS simulation training	Training	Description of 5 years of multidisciplinary ENTS simulation.	Significant improvement in three out of eight ENTS self-reported confidence domains. Global acceptability of simulation as a strategy to deliver ENTS training.	N/A	El Menabawey, T et al 45
ISREE strategy	Training and assessment	Multidisciplinary workshop with 35 participants. Theorising how ENTS will be incorporated into training pathways to improve endoscopy safety.	Development of 5-year implementation strategy. One domain is improving ENTS training.	N/A	Thomas-Gibson et al 47
ENTS video learning	Training	Development of simulated case using video media to highlight ENTS. Incorporated into regional endoscopic skills training.	Eight participants improved self-rated confidence in human factors. Resource-low method that can be incorporated into other training courses.	N/A	Macdougall et al 49

Description and results pertain to ENTS only.

DOPS, directly observed procedural skills; ENTS, endoscopic non-technical skills; ERCP, endoscopic retrograde cholangiopancreatography; ISREE, improving safety and reducing error in endoscopy; MARS, Multi-Assistant Rating Scale.